title: Risk of catecholamine crisis in patients undergoing resection of unsuspected pheochromocytoma.
abstract: OBJECTIVE
  To report the risk of catecholamine crisis in patients undergoing resection of unsuspected pheochromocytoma.
  
  
  METHODS
  Over a four-year period, we retrospectively identified four patients who underwent resection of adrenal pheochromocytoma in whom the diagnosis was unsuspected based on preoperative clinical, biochemical, and imaging evaluation.
  
  
  RESULTS
  None of the patients exhibited preoperative clinical features of catecholamine excess. Preoperative biochemical screening in two patients was normal. CT scan performed in all patients demonstrated a nonspecific enhancing adrenal mass. During surgical resection of the adrenal mass, hemodynamic instability was observed in two of four patients, and one of these two patients also suffered a myocardial infarct.
  
  
  CONCLUSIONS
  Both surgeons and radiologists should maintain a high index of suspicion for pheochromocytoma, as the tumor can be asymptomatic, biochemically negative, and have nonspecific imaging features. Resection of such unsuspected pheochromocytomas carries a substantial risk of intraoperative hemodynamic instability.
authors.affiliation: Department of Radiology, University of California, San Francisco, CA, USA.
authors.forename: Gina
authors.initials: G
authors.lastname: Song
authors.forename: Bonnie N
authors.initials: BN
authors.lastname: Joe
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Yeh
authors.forename: Maxwell V
authors.initials: MV
authors.lastname: Meng
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Westphalen
authors.forename: Fergus V
authors.initials: FV
authors.lastname: Coakley
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery*; D000328:Adult; D000368:Aged; D002395:Catecholamines / Q000032:analysis / Q000378:metabolism*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D002395:Catecholamines